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Home > Public Resources > Trauma Blog > 2016 - June > Teaching with the Journal of Traumatic Stress (JOTS): PTSD Over the Life Course

Teaching with the Journal of Traumatic Stress (JOTS): PTSD Over the Life Course

June 3, 2016

Most Introductory psychology books discuss posttraumatic stress disorder (PTSD) as a possible consequence of experiencing combat. Students may be curious to know how many members of the military experience PTSD, if it is possible to recover from PTSD, if it’s necessary to directly experience combat to develop PTSD, and how PTSD affects older people. It is not unusual for students to know a family member or client who served in combat, and to have some ideas about how different types of war experiences can give rise to different types of trauma reactions. This class activity focuses on a recent study on this issue. Below is a set of resources to use in class, and synopsis of the Magruder et al. (2016) and associated questions. As this article is available online (ISTSS membership login required), the answers to questions are omitted.

Resource

Magruder, K. M., Goldberg, J., Forsberg, C. W., Friedman, M. J., Litz, B. T., Vaccarino, V., Smith, N. L. (2016). Long‐Term Trajectories of PTSD in Vietnam‐Era Veterans: The Course and Consequences of PTSD in Twins. Journal of Traumatic Stress, 29, 5 - 16. DOI: 10.1002/jts.22075.

The Vietnam Veterans Memorial Fund includes a comprehensive set of teaching materials at http://www.vvmf.org/teaching-the-vietnam-era.

The 2015 PBS documentary The Last Days in Vietnam uses historical footage and interviews to show in a very compelling way the experience of the chaos of the evacuation of Saigon, with an unusual emphasis on the kinds of complex moral dilemmas inherent in the experience of serving. The associated website includes brief clips and a teachers’ guide: http://www.pbs.org/wgbh/americanexperience/features/introduction/lastdays-introduction/  

Max Cleland’s 2009 book Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove, is an unusually in-depth discussion of a lifetime of experiences following service.

PTSD Over the Life Course

In this study, how many participants developed PTSD for the first time well after the Vietnam War?

All Vietnam era vets were changed by the experience. But, not everyone who is exposed to a potentially traumatic event – even something as extreme as serving in the military during armed conflict – experiences PTSD. In fact, researchers are very interested in the incredible diversity of reactions to trauma. That includes a high degree of resilience overall, and interesting patterns of reactions over the lifespan. Magruder and colleagues (2016) published a study in the Journal of Traumatic Stress that sheds new light on these issues.

Magruder and colleagues (2016) followed up Vietnam era veterans, assessing PTSD symptoms in 1992 and 2012, to find out what happens to PTSD symptoms as veterans move through adulthood. They grouped veterans into five groups. One group never met criteria for PTSD. A second group met criteria soon after service, but recovered quickly. A third group met criteria soon after service and recovered later. A fourth group did not initially meet criteria, but did meet criteria later in life. A fifth group experienced chronic PTSD. The percentages of veterans in each category, based on 2012 data, are shown in Figure 1.

figure1.jpg

Figure 1. Percentage of Vietnam Era Veterans who Never Experienced PTSD, Experienced Early Recovery, Late Recovery, Late Onset, and Chronic PTSD

The researchers also examined the rates of other types of disorders among each of these groups. Rates of alcohol use disorder, substance abuse disorder, and generalized anxiety disorder were higher for those who ever met criteria for PTSD – regardless of chronicity or timing of onset – compared to those who never met criteria for PTSD.

Questions

What percent of Vietnam Era veterans ever experienced PTSD?
  a.    2%
b.    3%
c.    14%
d.    86%

In studies like these, we cannot assume that people are randomly assigned to combat or to not experience combat. It is a quasi-experimental design. That means:
   
               a.    The researchers cannot rule out all third variables.
b.    The researchers can be sure it was combat and not some other factor that caused some veterans to develop PTSD and others not.
c.    The study lacks an independent variable.
d.    The results are not is not statistically significant.
   

In this study, the same participants are followed through time. It is a prospective longitudinal study. A strength of that design is:
              a.    The researcher can rule out cohort effects – that is, that these findings are limited to people who were born in a particular era.
b.    The participants self-selected into the study, so we know they were motivated to participate.
c.    The researchers avoid bias that might be introduced if they only in 2012 selected willing participants who wanted to be part of the study.
d.    The researchers include only those people who are alive, can be located, and continue to participate over the decades.

It is rational to hypothesize that that people with PTSD use drugs and alcohol to self-medicate. If so, the researchers would expect to see the MOST drug and alcohol abuse among:
    a.    Those who never experienced PTSD.
b.    Those who experienced early recovery
c.    Those who experienced late onset.
d.    Those who experienced chronic PTSD.

About the Author

Kathryn Becker-Blease, PhD, is assistant professor in the School of Psychological Science at Oregon State University. Her research interests include developmental traumatology and the science of teaching and learning. She is Co-PI on an NSF-funded project focusing on teaching graph reading and research design skills in large introductory psychology classes using MCAT-style questions.